Non-medical use of methadone associated with higher hospitalization rates, greater ICU admissions, and worse medical outcomes.
By: Malissa Carroll
Wednesday, June 5, 2013
According to the results of a study published by the Maryland Poison Center (MPC) in the Journal of Emergency Medicine, significant differences exist in medical outcomes for individuals who use buprenorphine non-medically when compared to those who use methadone non-medically. The study, which involved data collected from the American Association of Poison Control Centers National Poison Data System from 2003 to 2009, found that non-medical use of methadone was associated with serious clinical effects, including respiratory arrest, coma, and death, while non-medical use of buprenorphine was often associated with mild clinical effects, with most patients treated and discharged directly from a hospital’s emergency department.
"The data we gathered support the conclusion that, although the non-medical use of buprenorphine is increasing, it is associated with markedly better medical outcomes than the non-medical use of methadone," says Suzanne Doyon, MD, ACMT, medical director of the MPC. "These findings can help physicians determine the appropriate triage and disposition of patients who arrive in the emergency department after misusing or abusing these drugs."
Researchers at the MPC launched this study after observing the amount of misinformation that existed regarding the misuse and abuse of buprenorphine and methadone, including a belief that the toxicity associated with the non-medical use of these drugs, which are used in the management of chronic pain and in the management of opioid dependence, is similar in severity and outcomes. Of the 1,920 cases reported to poison centers during the time data was collected for this study, 1,594 cases involved the abuse/misuse of methadone, while 326 were associated with the abuse/misuse of buprenorphine.
Outcomes measured as part of this study included treatments received, disposition, and poison center coding of final medical outcomes. Results from the study indicated that patients who abused/misused methadone were more likely to fare worse on all measures of health outcomes, with 26 deaths reported in the study. However, the risks associated with the abuse/misuse of buprenorphine were much less severe. There were no deaths reported in the buprenorphine group.
"In addition to an increased number of deaths and worsening of all measureable medical outcomes, our group also found that the non-medical use of methadone was associated with increased health care costs," says Doyon. "When we look at these results from a broader health care perspective, they suggest that providers consider all options when treating patients. They also illustrate the need for more patient education around the safe usage of opioids."
The MPC plans to conduct further research related to this study, including an assessment of medical outcomes in other populations, such as populations that use benzodiazepines non-medically along with opioids.